PsychEd Episode 35: Pain Psychiatry with Dr. Leon Tourian

PsychEd: educational psychiatry podcast

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.

This episode covers the psychiatric aspects of chronic pain with expert guest:

Dr. Leon Tourian, Associate Professor in the Department of Psychiatry at McGill University, and psychiatrist at the MUHC Alan Edwards Pain Management Unit.

The learning objectives for this episode are as follows:

By the end of this episode, you should be able to

1. Explore the role of psychiatry in the management of pain
2. Discuss the epidemiology of psychiatric comorbidities in pain disorders.
3. Outline the pathophysiology of pain and its relationship to psychiatric disorders.
4. Outline the role of non-pharmacological management/treatment of pain including psychotherapy and central neuromodulation
5. Discuss a general psychopharmacology approach in the management of pain relief and psychiatric comorbidities with chronic pain (including SNRI, TCAs, anticonvulsants, antipsychotics and cannabinoids).
6. Discuss the intersection of pain medicine with somatic symptom and related disorders

Guest: Dr. Leon Tourian

Hosts: Dr. Sarah Hanafi (PGY3), Dr. Nima Nahiddi (PGY3), Audrey Le (CC4)

Audio editing by Audrey Le

Show notes by Dr. Nima Nahiddi

Episode Infographic by Dr. Luba Bryushkova

Interview Content:

• Introduction and learning objectives – 0:00
• Role of psychiatry in management of chronic pain – 1:45
• Psychiatric co-morbidities in patients with chronic pain – 5:45
• Biological link between pain and psychiatric co-morbidities – 11:00
• Psychological approach to understanding and management of chronic pain– 14:30
• Central neuromodulation strategies for chronic pain – 21:00
• General pharmacological approach to the management of chronic pain – 22:30
• Pathogenesis of neuropathic and somatic visceral pain – 30:00
• Antipsychotics in the management of chronic pain – 37:00
• Cannabis in the management of chronic pain – 40:30
• Somatic symptom disorder – 46:00
• Stigma in chronic pain disorders – 53:10
• Treatment of somatic symptom disorder – 58:30
• Psychiatry and the stigma of chronic pain disorders– 61:00
• Closing remarks – 65:15

Articles and Resources:

Guideline for opioid therapy and chronic noncancer pain (CMAJ)

Guideline The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain (McMaster University)

List of Pain & Opioid Initiatives (2017) (CFPC)

Canadian Pain Task Force Report: June 2019

References:

Dersh, J., Polatin, P. B., & Gatchel, R. J. (2002). Chronic pain and psychopathology: research findings and theoretical considerations. Psychosomatic medicine, 64(5), 773–786. https://doi.org/10.1097/01.psy.0000024232.11538.54

Katz, J., Rosenbloom, B. N., & Fashler, S. (2015). Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 60(4), 160–167. https://doi.org/10.1177/070674371506000402

O'Connell, N. E., Marston, L., Spencer, S., DeSouza, L. H., & Wand, B. M. (2018). Non-invasive brain stimulation techniques for chronic pain. The Cochrane database of systematic reviews, 4(4), CD008208. https://doi.org/10.1002/14651858.CD008208.pub5

Ratcliffe, G. E., Enns, M. W., Belik, S. L., & Sareen, J. (2008). Chronic pain conditions and suicidal ideation and suicide attempts: an epidemiologic perspective. The Clinical journal of pain, 24(3), 204–210. https://doi.org/10.1097/AJP.0b013e31815ca2a3

Tunks, E. R., Crook, J., & Weir, R. (2008). Epidemiology of chronic pain with psychological comorbidity: prevalence, risk, course, and prognosis. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 53(4), 224–234. https://doi.org/10.1177/070674370805300403

CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.

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